Provider Demographics
NPI:1871116962
Name:EXTENSIVISTS OF TEXAS PLLC
Entity type:Organization
Organization Name:EXTENSIVISTS OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-730-5025
Mailing Address - Street 1:PO BOX 310332
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-0332
Mailing Address - Country:US
Mailing Address - Phone:830-730-8580
Mailing Address - Fax:
Practice Address - Street 1:1672 INDEPENDENCE DR STE 310
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-3982
Practice Address - Country:US
Practice Address - Phone:830-730-5025
Practice Address - Fax:830-730-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty